Implementation of liquid culture for tuberculosis diagnosis in a remote setting: lessons learned.

Although sputum smear microscopy is the primary method for tuberculosis (TB) diagnosis in low-resource settings, it has low sensitivity. The World Health Organization recommends the use of liquid culture techniques for TB diagnosis and drug susceptibility testing in low- and middle-income countries. An evaluation of samples from southern Sudan found that culture was able to detect cases of active pulmonary TB and extra-pulmonary TB missed by conventional smear microscopy. However, the long delays involved in obtaining culture results meant that they were usually not clinically useful, and high rates of non-tuberculous mycobacteria isolation made interpretation of results difficult. Improvements in diagnostic capacity and rapid speciation facilities, either on-site or through a local reference laboratory, are crucial

Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation

Joining up health and bioinformatics: e-science meets e-health

CLEF (Co-operative Clinical e-Science Framework) is an MRC sponsored project in the e-Science programme that aims to establish methodologies and a technical infrastructure forthe next generation of integrated clinical and bioscience research. It is developing methodsfor managing and using pseudonymised repositories of the long-term patient histories whichcan be linked to genetic, genomic information or used to support patient care. CLEF concentrateson removing key barriers to managing such repositories ? ethical issues, informationcapture, integration of disparate sources into coherent ?chronicles? of events, userorientedmechanisms for querying and displaying the information, and compiling the requiredknowledge resources. This paper describes the overall information flow and technicalapproach designed to meet these aims within a Grid framework

What's the issue here?: Task-based evaluation of reader comment summarization systems

Automatic summarization of reader comments in on-line news is an extremely challenging task and a capability for which there is a clear need. Work to date has focussed on producing extractive summaries using well-known techniques imported from other areas of language processing. But are extractive summaries of comments what users really want? Do they support users in performing the sorts of tasks they are likely to want to perform with reader comments? In this paper we address these questions by doing three things. First, we offer a specification of one possible summary type for reader comment, based on an analysis of reader comment in terms of issues and viewpoints. Second, we define a task-based evaluation framework for reader comment summarization that allows summarization systems to be assessed in terms of how well they support users in a time-limited task of identifying issues and characterising opinion on issues in comments. Third, we describe a pilot evaluation in which we used the task-based evaluation framework to evaluate a prototype reader comment clustering and summarization system, demonstrating the viability of the evaluation framework and illustrating the sorts of insight such an evaluation affords

The ‘ins and outs’ of faecal microbiota transplant for recurrent Clostridium difficile diarrhoea at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

Background. Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening condition that is becoming increasingly common. A persistent burden of this infectious illness has been demonstrated over the past 4 years at Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, South Africa, through implementation of active surveillance of hospital-acquired infections as part of the infection prevention and control programme. Oral treatment with metronidazole or vancomycin is recommended, but there is a major problem with symptomatic recurrence after treatment. Replacement of normal flora by the administration of donor stool through colonoscopy or nasogastric/duodenal routes is becoming increasingly popular.Objectives. To identify risk factors for the development of CDAD in patients referred for faecal microbiota transplant (FMT) and evaluate the safety of administration of donor stool as an outpatient procedure, including via the nasogastric route.Methods. A retrospective record review of patients with recurrent CDAD referred for FMT at WDGMC between 1 January 2012 and 31 December 2016 was conducted.Results. Twenty-seven patients were identified, all of whom fulfilled the criteria for recurrent CDAD. One-third were aged >65 years, and the majority were female. The most common risk factors were prior exposure to antibiotics or proton-pump inhibitors and underlying inflammatory bowel disease. Three procedures were carried out as inpatients and 24 in the outpatient gastroenterology unit. At 4-week follow-up, all patients reported clinical resolution of their diarrhoea after a single treatment and there were no recurrences. The FMT procedure was associated with no morbidity (with particular reference to the risk of aspiration when administered via the nasogastric route) or mortality.Conclusions. This case series confirms that FMT is a safe and effective therapy for recurrent CDAD. In most cases it can be administered via the nasogastric route in the outpatient department. We propose that the recently published South African Gastroenterology Society guidelines be reviewed with regard to recommendations for the route of administration of FMT and hospital admission. Meticulous prescription practice by clinicians practising in hospitals and outpatient settings, with particular attention to antimicrobials and chronic medication, is urgently required to prevent this debilitating and potentially life-threatening condition

Establishing a meaningful human rights due diligence process for corporations : learning from experience of human rights impact assessment

The United Nations Special Representative of the Secretary-General on Business and Human Rights, Professor John Ruggie, has constructed a new international framework, which is set to become the cornerstone for all action on human rights and business at the international level. The principle of human rights due diligence (HRDD) is the central component of the corporate duty to respect human rights within that framework. This article argues that Ruggie's HRDD principle contains the majority of the core procedural elements that a reasonable human rights impact assessment (HRIA) process should incorporate. It is likely that the majority of corporations will adopt HRIA as a mechanism for meeting their due diligence responsibilities. However, in the context of the contentious debate around corporate human rights performance, the current state of the art in HRIA gives rise to concerns about the credibility and robustness of likely practice. Additional requirements are therefore essential if HRDD is to have a significant impact on corporate human rights performance – requirements in relation to transparency; external participation and verification; and independent monitoring and review

The effectiveness of brief cognitive analytic therapy for anxiety and depression: A quasi‐experimental case—control study

Objectives To investigate the effectiveness of an 8‐session cognitive analytic therapy (CAT) protocol for patients with anxiety and depression in the context of relational problems, personality disorder traits, or histories of adverse childhood experiences and then to compare outcomes with cognitive behavioural therapy (CBT). Methods The study was conducted in a single Improving Access to Psychological Therapies (IAPT) service and used sessional outcome monitoring. Propensity score matching was used to derive equivalent CAT (N = 76) and CBT (N = 73) samples through matching intake characteristics. Longitudinal multilevel modelling (LMLM) compared patterns of symptomatic change over time between the two therapies. Results LMLM found no significant differences between CAT and CBT in depression, anxiety, and functional impairment outcomes and showed similar symptom change trajectories. Small between‐therapy post‐treatment effects and medium‐to‐large within‐therapy effects were found. CAT patients attended significantly more sessions, and the CAT dropout rate was significantly lower. Conclusions Brief CAT appears acceptable and effective for patients with anxiety and depression in the context of complex relational problems when delivered within the high intensity tier of an IAPT service. The potential added value of CAT in IAPT services is discussed. Practitioner points Practitioners (under appropriate supervision) could use 8‐session CAT when treating patients with anxiety and depression in the context of clinical complexity. The 8‐session CAT model holds organizational promise in IAPT services. Brief CAT interventions should retain theoretical integrity

Performance of the 2007 WHO Algorithm to diagnose Smear-negative Pulmonary Tuberculosis in a HIV prevalent setting

The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya